Provider Demographics
NPI:1871349977
Name:MATTHIESEN, KRISTINA (NBCHWC)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MATTHIESEN
Suffix:
Gender:F
Credentials:NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 RITA LN
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2120
Mailing Address - Country:US
Mailing Address - Phone:706-992-5629
Mailing Address - Fax:
Practice Address - Street 1:1105 RITA LN
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2120
Practice Address - Country:US
Practice Address - Phone:706-992-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA-3695065171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach